pt loc 1 - study questions exam 2-1

7/30/2019 Pt Loc 1 - Study Questions Exam 2-1

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Course: Point Location 1 Date: Nov 26, 2007Document: Study Questions Exam 2 on Wk 10

Study Questions Exam 2

Do:

Know Chinese names of all channels (i.e. Lung Lung Channel of the Hand Taiyin)

General path of each channel (i.e., lung begins at MJ, where it goes, etc.)

Know location of all acu points

Know categories of all points Know needle depths/angles of points

Know cautions/contraindications of points (like LI 4 not for preggers, ST 17 not for cupping)

Dont need to know for exams in this class:

Dont need to know paths of divergents, luos, just the main paths

Dont need to know chinese names of acupoints.

Dont need to know energetics/indications of any point for this class.

Know the following cun measurements:

From: Cun:

Axillary crease (anatomical neck of

humerus) to cubital crease

9

Lateral hairline to lateral hairline on

forehead

9

Distance between the mastoid

proceses on the back of the head

9

Front hairline to back hairline 12

Popliteal crease to lateral malleolus 16

Great trochanter (find this lying on

sidehighest point of hip) to

anterior popliteal crease

19

Du 20 to back hairline 7Back hairline to Du 14 3

Yintang to Du 14 18

Between medial borders of scapula 6


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Front hairline to back hairline 12 Between medial borders of scapula 6


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Lung Taiyin Channel of the Hand

Highlights of the Lung Taiyin channel of the hand.

1. Originates in Middle Jiao

2. Two branches split at LU 7a. Collateral channel:

Back of hand to LI channel on index fingerb. Part of Primary:

Branch to thenar eminence of the thumb

Point Categories Location Angle/Depth Caution/Contra

LU 1 Front Mu of Lung

Meeting pt of LU and SP

Level with 1st intercostal space 6 cun lateral

to midline and 1 cun inferior to LU 2

Methods to locate:1. Find 1st intercostal space.Find midline, measure 6 cun lateral.

2. Have pt raise arm straight out andparallel to ground.

Find hollow of delta/pec triangle.Measure down 1 cun.

Transverse oblique,

pointing laterally.0.5 0.8 cun.

Possible pneumothorax

with deepperpendicular needling.

LU 2 1 cun superior and slightly medial to LU 1in hollow of delta-pectoral triangle.

Can palpate when pt raises arm straight outand parallel to the ground.

Transverse oblique,pointing laterally.

0.5 0.8 cun.

Possible pneumothoraxwith deep

perpendicular needling.

LU 3 Window of Heaven/Sky 3 cun below tip of axillary fold, 6 cun

superior to cubital crease on upper arm,groove between lateral border of biceps

brachii and shaft of humerus.

To locate:

1. Divide distance between tip of

axillary fold and cubital crease

Perpendicular.

0.5 1 cun


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(9cun) into thirds.2. Find border between top 1/3 and

bottom 2/3.Point lies on this borderline in

groove between lateral border ofbiceps brachii and shaft of humerus.

3.

LU 4 In upper arm, groove between lateral borderof biceps brachii and shaft of humerus.

To locate:

1. Divide distance between tip ofaxillary fold and cubital crease

(9cun) into thirds.

2. Find border between top 1/3 andbottom 2/3. Go down 1 cun in

groove between lateral border ofbiceps brachii and shaft of humerus..

Perpendicular0.5 1 cun

LU 5 He Sea point of LUWater point of LU

Cubital crease of elbow in radial sidedepression next to the tendon of the biceps

brachii.

Slightly flex the elbow for easiest find.

Perpendicular0.8 1.2 cun

LU 6 Xi cleft point of LU On flexor aspect of forearm in a linebetween LU 5 and LU 9.

To locate:

1. Locate LU 5 and LU 92. Divide the distance between LU 5

and LU 9 in and go 1 cun

proximal on this line.Should be a palpable depression here.


LU 7 Luo connecting pt of LUCommand pt head/nape

Radial forearm superior to styloid processof radius. (abt 1.5 cun prox to LI5)

Between tendons of brachioradialis and

Pinch skin, insert eitherwith or against the channel.


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abductor pollicus longus

Convenient though not always accuratelocator: hook thumbs together and find

point where index finger tip falls.

Note: noton line with LU 5 and LU 9

Transverse0.5 1 cun per Deadman

0.3 0.5 per CAMS

LU 8 Jing River pt of LUMetal pt of LU

1 cun proximal to LU 9 in a line connectingLU 5 and LU 9

Find the depression at the base of the styloid

process radius and the radial artery. Point isbetween these 2.

Oblique (proximally)Perpendicular

0.3 0.5 cun.

Beware of the radialartery!!

Takes about 5 minutes

to stop bleeding shouldyou hit it.

LU 9 Shu Stream pt of LU

Yuan Source pt of LU

Hui Mtg pt of VesselsEarth pt of LU channel.

At wrist joint in depression between radial

artery and tendon of abductor pollicus

longus (thumb tendon) on border ofpisiform bone.

Level with Heart (HE) 7 point.

Perpendicular

0.3 0.5 cun per Deadman

0.2 0.3 per CAMS

LU 10 Ying Spring pt of LUFire pt of LU

On thenar emminence, midway down theshaft of the 1st metacarpal (thumb).

Locate the point on the border of the redand white skin (or where skin changes

textures)


LU 11 Jing Well pt of LU

Wood pt of LUGhost pt (sun simiao)

Outer corner of thumbnail.

To locate:

Draw a line down the radial edge of the nailand along the base line of the nail. Point is

locate on their intersection.

0.1 cun from corner of nail.

Best to use acupressure or

for bleeding techniques.

Perpendicular orOblique (proximal)

0.1 0.2 cun

Or prick to bleed


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Large Intestine Yangming Channel of the Hand

Highlights of the LI channel

1. Channel crosses midpoint of body, ends on opposite side from start.

2. LI 4 is command pt for face/moutha. Use right LI 4 to treat problems no left face/mouth

b. Use left LI 4 to treat problems on right face/mouth3. Bilateral channel

4. Twenty points going from lateral index finger nail to naso-labial groove at side of the wing of the nose.


LI 1 Jing Well pt of LIMetal pt of LI

Radial edge of corner of index fingernail.

Draw a line down from radial border of thenail and the base of the nail. Junction ofthese lines is the point, approx 0.1 cun from

the corner of the nail.

Perpendicular or oblique0.1 0.2 cun

Alternatively,Prick to bleed.

LI 2 Ying Spring pt of LI

Water pt of LI

Radial border of index finger in a

depression just distal to the flare of themetacarpo-phalangeal joint.

Located where the skin changes color

and/or texture.

Easier to find if patient makes a loose fist

Oblique (prox or dist)

0.2 0.3 cun

Perpendicular-obliquetowards palm

0.5 cun

LI 3 Shu Stream pt of the LIWood pt of the Li

Radial border of the 2nd metacarpal bonejust proximal to the flare on the distal head

of the bone. Find the depression here.

Located where the skin changes

color/texture.

Easier to find if patient makes a loose fist.



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LI 4 Yuan Source pt of LICommand pt face/mouth

Note:

LI 4 + LV 3 = 4 gates

Most accurate:1. find the middle point of the 2nd

metacarpal bone2. find the mid distance between the 2nd

metacarpal and the 1st metacarpal (pre-thumb).

3. go in toward the 2nd metacarpal bone a

bit.

Convenient but less accurate:1. stretch your thumb and forefinger out in

an L shape to create a tight edge in the

webbing between the two.2. place the mid line of the bend of your

opposite thumb on the tight edge from

step 1.3. bend the thumb here to that the tip

touches between the 1st and 2nd

metacarpals.


Contraindicated forpregnancyunless

youre trying to inducelabor.

LI 5 Jing River point of LI

Fire point of LI

In anatomical snuffbox just across from

the transverse crease of the wrist (where LU9 is)

1. Stretch hand out like shaking hands.

2. Cock thumb back3. Point is in the hollow created

between the thumb (extensor

pollicus longus) and the brevis(tendon leading to the thumb on

radial edge of wrist).

Dont needle too proximally!

Perpendicular

0.5 0.8 cun

Caution: avoid cephalic

vein. Cover it withfingertip, needle next to

the nail.


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LI 6 Luo Connecting pt of LI(fx both LU and LI)

Locate LI 5 and LI 11

first!

Locate LI 5 and LI 11 first. Point is on aline between these two, 3 cun proximal to

LI 5, 9 cun distal to LI 11.

1. Find LI 5 and LI 11.2. Use a measure - tape, string, paper, edge

of sheet, etc - to mark the distance (12

cun)3. Divide the distance in to find

midpoint. (6 cun)4. Mark the midpoint and divide the distal

into half again. (3 cun)

This is LI 6.

(3 cun above crease, 9 cun distal to LI 11)

Perpendicular0.5 0.8

LI 7 Xi Cleft point of LI Locate LI 5 and LI 11 first. Point is on a

line between these two, 5 cun proximal to

LI 5, 7 cun distal to LI 11.

Combine proportional and thumb 1 cun tofind this.

1. After locating LI 5 and 11, use a

tape or string to find the waypoint between the two.

2. Measure 1 cun distal to this location.

This is LI 7.

Perpendicular 0.5 1 cun


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LI 8

Note: LI 8-10 are all 1

cun apart!!!

Measure from middle ofdot, not edges!

Locate LI 5 and LI 11 first. Point is on aline between these two, 4 cun distal to LI 11

(8 cun proximal to LI 5)

1. Use a tape measure or string to find the mark between LI 5 and 11.

2. Half this again to find the mark.

3. Measure distal from LI 11 and then add1 more cun distal

Should be 2 cun away from LI 9


LI 9

Note: LI 8-10 are all 1cun apart!!!

Locate LI 5 and LI 11 first. Point is on a

line between these two, 3 cun distal to LI 11

(9 cun proximal to LI 5)

1. Use a tape measure or string to find the mark between LI 5 and 11.

2. Half this again to find the point.


Perpendicular

0.5 1 cun

LI 10

Note: LI 8-10 are all 1

cun apart!!!

Locate LI 5 and LI 11 first. Point is on a

line between these two, 2 cun distal from LI11 (10 cun proximal to LI 5)

Method 1: find LI 8 and divide distance in

half.

Method 2: Find LI 9, measure proximally

by 1 cun.


Perpendicular

0.5 1 cun

(good for acute lumbar

pain insert then do mildactivity in the area of the

pain, pushing up to painthreshold, but not injuring)


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LI 11 He Sea pt of LIEarth point of LI

Ghost point (sun sim)

At elbow mid way betweenLUNG 5 andlateral epicondyle of humerus

Location:

1. Fully flex elbow. Point is located atthe radial end of the cubital

transverse crease.

2. If cant flex elbow: find LU 5 andlateral epicondyle of humerus. Point

is radial to the tendon of the bicepsbrachii.

Perpendicular1 1.5 cun

LI 12 Locate by landmarks, not by cun measures.

Locate with elbow flexed to 90 degrees.

Palpate lateral epicondyle of humerus.Find the humeral shaft, run finger downuntil you feel the curve begin.

Not in line with LI 11and LI 14. Backward abit.

Perp 0.5 1 cun

LI 13

Find LI 11 and 15 first

Find LI 11 and LI 15. This point lies inlinebetween them, 3 cun prox to LI 11, 6 cun

distal to the axillary fold.(Also is inline withLU3 and 4)

1. Use a measure to find distance

between LI 11 and axillary fold.

2. Divide this into 1/3s.3. Point is located on border between

distal 1/3 and prox 2/3 in thedepression between the lateral

border of the biceps brachii and the

shaft of the humerus.



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Finger cun and proportional measurementsare about the same here, but proportions are

more accurate. But you can use 1 handbreadth above LI 11 on line between LI 11

and 15.

LI 14

Find LI 11 and 15 first

Lateral side upper arm, in visible depression

formed by the distal insertion of the deltoidand brachialis. Tense the arm to feel/see

more easily.

Inline with LI 11-15

Note: some ppl have bigger delts from

working out and such, so may not be so

reliable.

I found this by finding the delt tip, up by ~ 1

cun

Oblique 1 1.5 cun

LI 15 Locate by landmark only!!

In depression anterior and inferior to the

acromion at the origin of the delt.

Hold the arm out (airplane) to see thedepression here. Women and overweight

ppl will have softer definiton here.

SJ 14 is the depression on the back side of

the acromion.

Move your angle of vision to see it better.

Trans/Oblique

0.8 1.5 cun


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Again, this is on the opposite side of themidline from where you started!

LI 20

Terminus of the LI

channel

Located in naso-labial groove level with the

midpoint of the lateral edge of the wing ofthe nose (ala nasi)

Opposite side of the body across the midlinefrom where the channel started!

Transverse insertion

directed medio-superiorly.0.3 0.5 cun

Contraindicated for

moxa.

Stomach Yangming Channel of the Foot

Highlights of the Stomach Yangming Channel of the Foot

1. Originates at LI 20 in naso-labial groove lateral to the wing of the nose.2. ST 8 doesnt connect to ST 9, but to ST 5

3. Split in ST channel around ST 5.

4. ST channel goes to upper gums. For numbness/pain/swelling in upper gums, use points on legs for ST.5. Three branches of ST channel

a. Lower anterior aspect of midline on top of foot, terminates at ST 45 - lateral aspect of 2nd toe nail lower corner.b. Split at ST 36, down lateral aspect of lower leg, terminates at lateral aspect of 3rd toe.

c. Split at ST 42, oblique across foot to meet SP 1at medial aspect of great toe.

What do you need to do/know about needling around the eyes? (esp ST 1)

1. Need good communication with your patient they need to know what youre going to do, what the risks are, what to expect. Bruisingis a real possibility.

2. CNT techniques should be strictly applied. High risk of infection.3. Select short, thin needles.

4. Use a clean dry cotton ball to push the closed eye up and away from the insertion site.

5. Insert slightly downward, then push in no more than 0.2 0.5 cun perpendicular.6. No manipulation, no retention.

7. Press 1 minute after withdrawl, have pt hold another 2-3 minutes.8. In the event of hematoma, ice 24-48 hours, then switch to heat to speed healing of bruises.


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9. No moxa!!!


ST 1 Locd mid between inner and outer canthus

between pupil of eyeball and infraorbital

ridge.

Method 1:Have patient look straight ahead, go down

between infraorbital ridge and eyeball

Method 2:

Find the midline between the inner andouter canthus. Find infraorbital

ridge/eyeball space.

Have pt look upward

w/eyes closed. Use a dry

cotton ball to push eyeballupwards and away from

insertion point.

0.2 0.5 cun

Moxa contraindicd

(smoke and burns)

CNT practices

Communicate w/pt

Risk of hematoma

use short/thin

needles

Dont manip/retain.

Press 1 min when

w/draw, have ptpress addit 2-3

minutes.

ST 2 Located by landmark only.

Located directly below midline of eye

(below pupils when looking straight ahead)in the depression of the infraorbital foramen

depression on the infraorbital ridge.

Location: Inline with ST 1 and ST 3

Perpendicular (very

superficial)0.2 0.4 cun

Moxa

contraindicated.

No

lift/thrust manip.Damage to

infraorbital nerve in

foramen

Deep

insertion could injureeyeball, but hard to

do.

ST 3 Below ST 1 and 2 (usually in a line with

them, not always), level with the lowerborder of the wing of the nose (ala nasi) on

the lateral side of the naso-labial groove.

Might need to have pt smile to find groove

Perpendicular

0.5 0.8 cun

ST 4 0.4 cun lateral to corner of mouth. Perpendicular


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Generally in line with ST 1-3, but not

always.

Should be in the naso-labial groove.

0.2 0.3 cun

Transverse/oblique towardanother feature (usually

ST 6)

0.5 0.8 cunST 5 Dont get this one too high!!

1. Clench teeth.

2. Feel for the masseter muscle at theangle of the jaw.

3. Find the anterior border of thismuscle.

4. Go 0.5 cun above lower border of

the mandible bone at this location.

Oblique

0.3 0.5 cun

Theres an artery here

to avoid.

ST 6 Ghost point (sunsim) Dont get this one too high either!!

Located on the prominence (highest point)

of the masseter (chewing) muscle, 1fingerbreadth anterior/superior to angle of

the jaw about 45 degree angle from corner

of jaw.

Have pt clench teeth to find it, relax toneedle it.


Transverse toward anotherpoint.

ST 7 Located in the zygomatic arch, usually just

anterior to the ear hole.1. Find the depression just in front of

the ear in the zygomatic arch (ridge

of cheekbone as it approaches theear.

2. Have pt open mouth, should feel abone pop into this depression.

Perpendicular and slightly

inferior0.5 1 cun

ST 8 Corner of the forehead, 4.5 cun lateral to Du Oblique or transverse Contraindicated to


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24, 0.5 cun within anterior hairline. Smalldepression here.

Three methods for locating.

Method 1:

1. Find the corner of the hairline2. Go back 0.5 cun within anterior

hairline.

Method 2:1. Double the distance from GB 15

(0.5 cun into hairline and above

midline eye) to Du 24 (0,.5 cun intohairline and above midline of body)

2. Go lateral from midline of body at

Du 24 this distance.

Method 3:

1. 4.5 cun (5 fingers) from midline of

hairline (remember its 3 cun fromYintang up to hairline)

2. 0.5 cun posterior into hairline.

0.5 1 cunInto the 4th layer of the

scalp in loose cnx tissue

moxabustion

Not perpendicular!

ST 9 Window of heaven More closely related to ST 5 than to ST 8!!!

1. Find the tip of the adams apple

(laryngeal prominence)2. Have pt turn head to side3. Go lateral, level with adams apple

tip, to the anterior border of thesternal head of the SCL. Point is just

anterior to this border.

Carotid artery is here palpate for it then

use pressing to hold it aside for puncture

Perpendicular

0.5 1 cun

1. Contraindication:

Moxa contrad.Burns infect,

carotid arterymoves it thru thebody.

2. Caution: Carotidartery located here

ST 10 On neck, anterior border of SCL sternal Perpendicular 1. Contraindication:


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Find ST 11 first!!

head, midway between ST 9 and ST 11but not inline with them.

The 3 of them make a shallow triangle.

Have patient turn their head to the sidewhile you apply resistance to the chin to

make this area more prominent.

0.3 0.5 cun Moxa contrad.Burns infect,

carotid arterymoves it thru the

body.

2. Caution: Carotidartery located here

ST 11 Located at root of neck in the depressionlocated just above the collar bone in the

triangle formed by the sternal and clavicularheads of the SCL muscle.

Have pt turn their head to the side to see this

triangular depression.


1. Small artery here2. Deep insertion =

risk ofpneumothorax

ST 12 Meeting pt of ST, LI, SI,SJ, GB!!

Know this! Can stim

many areas w/o adding

more points.

1. Find midpoint of clavicle2. Go up into supraclavicular fossa.

Point is located at the upper border of the

clavicular bone in the fossa.

Safer:

Transverse posterior

toward trapezius muscle0.5 1 cun

Not so safe:

Perpendicular

0.3 0.5 cun

Contraindicated inpreggers.

ST 13-18: on mamillary line 4 cun lateral to the midline of the body. Two methods to locate mamillary line:1. Use finger cun 4 cun from midline

2. Find midpoint of clavicle then go downward. More accurate than the finger cun method.

Point Categories Location Angle/Depth Contraindic/Cautions

ST 13 On mamillary line. Directly below ST 12just below the inferior border of the

clavicle.

Transverse, aiming towardmanifestation

0.3 0.5 cun

Deep or perpendicularinsert carries risk of

pneumothorax and/orinjuring subclavian

vessel

ST 14 Middle of the 1st intercostal space on the Transverse, aiming toward Deep or perpendicular


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mamillary line

Note that the intercostal spaces curveupward as they go lateral

manifestation0.3 0.5 cun

insert carries risk ofpneumothorax

ST 15 Middle of the 2nd intercostal space onmamillary line.


0.3 0.5 cun


pneumothorax

ST 16 Middle of the 3rd intercostal space on themamillary line


0.3 0.5 cun


pneumothorax

ST 17

UniqueLandmark point

Technically in the middle of the 4thintercostal space, but always located in the

center of the nipple regardless of where thatfalls.

Dont!!! Contraindicated for everything this is a

landmark only.

ST 18 Middle of the 5th intercostal space, onmamillary line. Might need to push breast

up to find this intercostal.

Some books say is in 5th intercostal just

below nippleaint necessarily so.


0.3 0.5 cun


pneumothorax


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Stomach 19-25 are all upper abdominal points. Lie on a different line than 13-18 located 2 cun from the midline.

To find 2 cun you can do any of these:1. Measure with finger cun least reliable.

2. Measure way between mamillary line and the midline. Probably the best.

3. On a muscular patient with 6-pack abs look for the ridge.

Location for these points works like this:1. Find the center of the umbilicus and the sternal costal angle. Distance between these = 8 cun.

2. Divide the distance in half. 4 cun. This is ST 21.

3. Divide the upper half again 2 cun. This is ST 194. Divide the lower half into halves this is ST 23.

5. ST 25 is on either side of the umbilicus.Other points (even points) lie exactly inbetween.


ST 19 2 cun lateral to midline. Locate as described

above, locate ST 21 first, then ST 19

Perpendicular

0.5 1 cun

Deep insertion may

injure heart (left), liver(right) if either organenlarged.

ST 20 See location notes above and locateaccordingly


In thin subjects deepneedle can puncture

peritoneal cavity.

On right side if liver isenlarged can penetrate.



In thin subjects deepneedle can puncture

peritoneal cavity.

On right side if liver is

enlarged can penetrate.

ST 22 See location notes above and locate

accordingly

Perpendicular

0.5 1 cun

In thin subjects deep

needling can punctureperitoneal cavity.


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In thin subjects deepneedling can puncture

peritoneal cavity.

ST 24 See location notes above and locate

accordingly

Perpendicular

0.5 1 cun


needling can puncture

peritoneal cavity.ST 25 Front Mu point of LI 2 cun lateral to umbilicus Perpendicular

1 1.5 cunIn thin subjects deepneedling can puncture

peritoneal cavity.

ST 26 30 are lower abdomen points. Cun measures here are larger than the thumb width, so use proportional measures.

1. Palpate for top margin of the pubic bone.Be sure you communicate well with your patient, telling them what youre palpating for, what these points will do for them, etc. They

may be more comfortable finding this for you. More on that in a minute.2. Find the center of the umbilicus

ST 26 through ST 30 are located 2 cun lateral to this line on both sides of the body.

3. Find the location by dividing the distancea. Divide the distance between the umbilicus mark and the top margin of the pubic bone in half. This is a reference point

b. ST 27: Go cun above the middle mark in 3a.c. ST 26: Go way between ST 27 and ST 25.

d. ST 28: Go cun below the middle mark in 3a.

e. ST 30: Top margin of the pubic bone, 2 cun lateral from the midline.f. ST 29: Go way between ST 30 and ST 28.


ST 26 See location notes above Perpendicular

1 1.5 cun



ST 27 See location notes above Perpendicular

1 1.5 cun




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ST 28 See location notes above

KNOW: for Abdominal Edema


In thin subjects deepneedling can puncture

peritoneal cavity.

ST 29 See location notes above

KNOW: for irregular menstruation

Perpendicular

1 1.5 cun



ST 30 Level with superior border of pubic

symphysis, 2 cun off of midline

Perpendicular

0.5 1 cun

Contraindication: No

Moxa!Cautions:

Deep insert superiordirection can =

penetration peritonealcav or full bladder. On

men, can penetratespermatic cord.

ST 31 Located on upper thigh.To find:

1. Find ASIS and lower border ofpubic symphysis

2. Draw a line down from ASIS andover from pubic symphysis.

Intersection is ST 31.

Perpendicular

1-2 cun

ST 32 Locate 32-24 with knee flexed

1. Draw a line from ST 31 lateralsuperior corner of patella.

2. Locate point 6 cun above superiorborder of patella on this line.

Alternately, you can draw a line from the

ASIS to the superior lateral corner of the

patella and locate the point on this line.

Perpendicular

1-2 cun


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ST 33

Easy to locate, but oftenmistaken on exams

Locate 32-24 with knee flexed

On same line as ST 31 and 32, 3 cun abovesuperior border of patella or 1 cun above ST

34.


ST 34 Xi Cleft point of ST Locate 32-24 with knee flexed

Three methods to locate this:1. Three fingers to 2 cun measure

2. Best: Measure length of knee cap (2cun) with fingers. Go up above superior

border this distance then rotate fingers45 degrees laterally.

3. Locate point in bulge of vastus lateralis


ST 35 Locate with knee flexed

Level with lower border of patella andlateral to the ligament, yet lower than where

the patella is.

This ligament looks like an oxs nose where

youd put the ring through. Use the topdepression here, not the lower one.

Note: Extrapoint called Xiyan is in the same

place, but both lateral and medial, so ST 35overlaps.

Oblique towards

middle/back of poplitealcrease UB 401 1.5 cun

Insertion into joint

capsule carries risk ofinfection of capsule.

ST 36 He Sea of ST & Earth ptLower He-Sea of ST

Command pt (ab diss)

Ways to find this:

1. Proportional method is better than 3 cun

hand method, but hand method is close.Three cun below ST 35

2. Body landmarks:Where tibia flares and 1 finger wid off

bone crest.



24/33


Highlights to know

1. Makes sure ST 35 iscorrect.

2. One fingerwidth

lateral to crest of tibia.3. Know locating

methods

Level with lower border of tuberosity oftibia, 1 fingerwid lateral to bone crest.

3. Find ST 38/40 (in middle 8 cun between prominence of lateral malleolus

and tibiofemoral joint/popliteal crease).

Divide distance from here to poplitealcrease to get 4 cun. Go proximal by 1

cun.

ST 37 Lower He Sea pt of LI Lower leg, 3 cun inferior to ST 36, 2 cun

above ST 38.

1. Find ST 38. This is the midmarkbetween prominence of lateral

malleolus and the tibio-femoral joint

crease (level with poplit.crease). It is

8 cun to both extremes.2. Divide the distance between ST 38

and the popliteal crease level into

and into again to get 2 cun above

ST 38.3. Use middle or index finger to

measure 1 finger breadth lateral toanterior crest of tibia. This is ST 37.

4.

Perpendicular

1 1.5 cun

ST 38 1. Use a measure (tape, string, etc) to

find the distance between the tibio-femoral joint line (even with the

popliteal crease) and the lateral

malleolus.2. Divide this in half, measuring up

from the lateral malleolus.3. Mark a spot at this level, one

fingers breadth lateral to the

anterior crest of the tibia. This is ST38.

Perpendicular

1 2 cun

You can also thread from

here to UB 57 (at the backof the calf near the base of

the calf muscles)


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ST 39 Lower He Sea pt of SI Located 1 cun below ST 38. See measuretechniques for ST 38 above.

Be sure to go one fingers breadth lateral to

anterior crest of the tibia.


ST 40 Luo connecting pt of ST Level with ST 38. See location notes above.

2 fingers breadth lateral to the anteriorcrest of the tibia.


ST 41 Jing River point of STFire point of ST

On the ankle, level with the prominence ofthe lateral malleolus.

1. Slight dorsal-flex the foot to see the

depression here. There are 3 majortendons here: tibialis anterior (most

medial), extensor hallicus longus(going to the big toe), and extensordigitorum longus (most lateral - goes

to remaining 4 toes).2. Find the depression between

extensor hallicus longus and

digitorum longus at the bend of theankle. This is ST 41


Caution: anterior tibialvessels/nerve lie deep

to this point.

ST 42 Yuan Source for ST

Hard to find

Located on dorsum of foot in a depressionformed where the 2nd and 3rd metatarsals

meet the cuneiform bones.1. Find the depression between the 2nd

and 3rd metatarsals.2. Slide your finger proximally and

find the end of the depression.

3. Keep going proximal and feel for adepression on the other side of the

flare of the metatarsals.

Good luck with that.


Caution: dorsalis pedisartery here. Feel for it,

use pressing tech ifpossible.


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ST 43 Shu Stream pt of STWood pt of ST

Located between 2nd and 3rd metatarsalbones.

1. Curl toes so you can see the

knuckles.

2. Locate the depression between the2nd and 3rd metatarsals. Point is in a

depression just proximal to theknuckles, just below the flare at the

distal end of the metatarsals.


ST 44 Ying Spring pt of STWater pt of ST

Located between 2nd and 3rd metatarsalbones.

1. Curl toes so you can see the knuckles.

2. Locate the depression between the 2ndand 3rd metatarsals. Point is in adepression just distal to the knuckles.


ST 45 Jing Well pt of STMetal pt of ST

Located on 2nd toenail, lateral side, bottomcorner.

1. Intuit a line drawn along the lateralborder of the nail and the base of the

nail.2. Point lies on this junction at the

lateral aspect of the 2nd toenail.


Alternatively, prick tobleed.


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Spleen Channel of the Foot Taiyin

What channel does the Spleen Channel change positions with, which is anterior and posterior, and where do they change positions?

The SP channel changes positions with the LV channel 8 cun above the medial malleolus. Up to this point the Liver channel is anterior. Afterthis measurement the Spleen channel is anterior and the Liver channel is posterior.

Does the Spleen channel go above the neck? If so, where does it go?

Yes, it does. It travels under the lower surface of the tongue to the root of the tongue (Heart channel is on the upper surface)

Briefly describe the path of the Spleen channel.

Begins at the medial corner of the nail of the big toe (SP 1)

Runs along the medial aspect of the foot on the border where the skin changes color/textureLower leg: Follows the posterior border of the tibia on the medial aspect.

Upper leg: ascends along antero-medial aspect of the thigh.Trunk: intersects Conception vessel, enters Spleen, cnx with Stomach. Runs 6 cun lateral to midline

Point Category Location Needling Caution/Contra

SP 1 Jing Well

Ghost point (SSM)

Medial/dorsal aspect of big toe 0.1 cun from

the corner of the nail.

Draw a line down the medial aspect of the

nail and another across the lower border ofthe nail. The intersection is the point.

Perp or oblique 0.1 cun

Moxa

SP 2 Ying Spring Medial side of the big toe in a depression

distal/inferior to the first metatarso-phalangeal joint, almost on the bottom of

the bone.

1. Curl the toes to see the knuckle, uncurlto locate.

Perp 0.3-0.5 cun


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2. Slide fingertip distally over the side ofthe ball of the foot to find the

depression.3. Locate the point on the border where

skin changes color/texture.

SP 3 Shu Stream

Yuan Source

Medial inferior side of the foot in the

depression proximal to the head of the firstmetatarsal bone (almost under the foot).

1. Find the ball of the foot by curling the

toes.2. Slide your fingertip proximally over the

side of the ball of the foot to find the

depression.

3. Locate the point on the border whereskin changes color/texture.

Perp 0.5 1 cun

SP 4 Luo Connecting

Confluent Pt of the

Penetrating Vessel

Medial side of foot in depression

distal/inferior to the base of the first

metatarsal.

1. Palpate along the shaft under the foot tofeel.

Beware of the deeper depression and seeif it goes all the way up to the top of the

footif so, youre too proximal and

youre on the MT joint.2. Locate the point on the border where the

skin changes texture/color

Perp 0.5 1 cun

SP 5 Jing River Anterior and inferior to the medial Perp 0.3 0.5 cun


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malleolus.

1. Observe first look for the bulge andthe depression here.

2. Draw a line along the anterior border of

the prominence of the medial malleolusand the inferior border of the medial

malleolus.3. Locate the point on the intersection of

these lines in the depression that youwill find here.

SP 6 Meeting point of the SP,

LIV, and KI channels

On medial aspect of lower legjustposterior

to the medial crest of the tibia, 3 cun

superior to the prominence of the medial

malleolus.

While proportional measure is more

accurate, its 15cun from medial mal to the

popliteal creaseif you can do 20% of this,bully for you, if not, use hand cun measure.

Perp 1-1.5cun Contra: preggers

SP 7 On medial aspect of the lower leg, 6 cun

proximal to the tip of the medial malleolus.Locate the point just posterior to the medial

crest of the tibia.

Locate this point in relation to SP 6.

Measure 1 hand-breadth above SP 6.

Perp 1-1.5

SP 8 Xi Cleft of SP channel Medial leg 3 cun inferior to SP 9 in adepressionjustposterior to the medial crest

of the tibia. Might be slightly more anteriorthan SP 9 due to the curvature of the bone.

Perp 1-1.5cun


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To locate:1. Locate SP 9 first, then distal by 1

handbreadth.2. Alternately, divide 15cun between pop

crease and the medial mal into 1/3s and

locate this point at the border betweenthe top 1/3 and bottom 2/3s.

SP 9 He Sea Point of SP Medial side of lower leg in a depression at

the angle formed by the medial condyle ofthe tibia and the posterior border of the

tibia.

Run finger in the groove posterior to tibias

medial border until you find the point where

the bone curves back. Point is located in thedepression here. (FYI, located at same levelas GB 34)

Perp 1 1.5 cun

SP 10

#1 point for Blood

tonify and move blood,skin problems. To treat

wind, treat the blood.

Two cun proximal to the superior border of

the patella on the medial side on the bulge

of the vastus medialis.

Locate this point like ST 34 flex the knee,then use the kneecap as a measure, go above

the superior border of the patella this much,rotate medially by 45 degrees.

Perp 1 1.5 cun

SP 11 Medial side of thigh, 6 cun proximal to SP

10 inline with SP 10 and SP 12.

To locate, find SP 10, go 6 cun proximal.

Alternately, find the way distancebetween SP 12 and the tibiofemoral joint

(pop crease).

Perp 0.5 1 cun Caution: deep needling

can puncture the

femoral artery


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SP 12 Meeting point of SP &

LV with Yin Linking

Not commonly usedNot strong function

Three point five (3.5) cun lateral to Ren 2

(top margin of the pubic symphysis level

with ST 30, but on the anterior midpoint) or1.5 cun lateral to ST 30 on the lateral side of

the femoral artery.

1. Locate upper border of pubic symphysisat the level of the anterior midline of the

body. Go lateral 3.5 cun from here.2. Locate the pulse of the femoral artery on

this line.

3. Locate SP 12 immediately lateral in the

depression

Perp 0.5 1 cun Caution: deep needle

medially may puncture

the femoral artery whiledeep needling laterally

can puncture thefemoral nerve!

SP 13 Meeting pt of SP & LIV

with Yin Linking

Lower ab, .7 cun superior, .5 lateral to SP

12, 4 cun lateral to the midline of the body.

To locate, find SP 12. Measure 1 cun

diagonally (lateral and superior). Thisshould be about right. Verify that you are 4

cun lateral to the midline (on the samevertical level as the mamillary line)

Perp 1-1.5 cun Caution:

Possible peritonealpuncture with deep

needling in thin

patients.

SP 14 (NOT part of SP/LIV

meeting with YinLinkingwill be on test!)

Lower ab, 1.3 cun inferior to SP 15 (level

with umbilicus), 4 cun from midline.

Shen says measure to 1.25 cun and that

should be fine. On same vertical as themamillary line.

Perp 1-1.5 cun Caution:

Can punc peritonealcav in thin patients if

deep needle.

SP 15 Meeting pt of SP & LIV

with Yin Linking

Four (4) cun lateral to the center of the

umbilicus. (In the depression at the lateral

Perp 0.5 1 cun Cautions:

1. Possible peritoneal


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border of the rectus abdominis muscle ) cav punc in thins.2. Enlarged liver or

spleen at this level.

SP 16 Meeting pt of SP with

Yin Linking

On ab 3 cun superior to SP 15 and 4 cun

lateral to the midline on lateral border of

rectus abdominis muscle.

Perp 0.5 1 cun Cautions:

1. Possible peritoneal

cav punc in thins.2. Enlarged liver or

spleen at this level

SP 17 20 are 6 cun lateral to anterior midline, inline with LU 1 and 2. Needle all of them transverse with intercostal spaces 0.5 0.8 cun

deep. Guide needle towards manifestations that need help.


SP 17 Lateral side of chest, 5th intercostal space, 6

cun to midline.

1. Find the 6 cun mark from midline.a. Same line as LU 1 and 2

b. 8 fingers from anterior mid

c. Mamillary line + 2 cun2. Count to the 5th intercostal space (bout

level with the bra-line)

Trans-obl, 0.5 0.8 cun

either lateral or medial

Caution: perp insert =

risk of pneumothorax.

SP 18 Lateral side of chest, 4th intercostal space, 6

cun to midline.

1. Find the 6 cun mark from midline. 3ways:

a. Same line as LU 1 and 2b. 8 fingers from anterior mid

c. Mamillary line + 2 cun.2. Count to 4th intercostal (almost always =

nip level on dudes)






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SP 19 Lateral side of chest, 3rd intercostal space, 6

cun to midline.

1. Find the 6 cun mark from midline. 3

ways:a. Same line as LU 1 and 2

b. 8 fingers from anterior midc. Mamillary line + 2 cun.

2. Count to 3rd intercostal space.





SP 20 Lateral side of chest, 2nd intercostal space, 6cun to midline.

1. Find the 6 cun mark from midline. 3ways:

a. Same line as LU 1 and 2b. 8 fingers from anterior mid

c. Mamillary line + 2 cun.

2. Count to 2nd intercostal space.

Trans-obl, 0.5 0.8 cuneither lateral or medial

Caution: perp insert =risk of pneumothorax.

SP 21 Great Luo Connecting ofthe Spleen

Located on the mid-axillary line (from frontedge of armpit crease to back edge), level

with the 6th or 7th intercostal space

Trans-obl along intercostalspace 0.5 1 cun

Caution: perp insert =risk of pneumothorax.

pt loc 1 - study questions exam 2-1

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